IDweek 2013HBeAg阴性病毒复制高和ALT水平正常的肝组织学检查结

StephenW

1770. Analysis of liver histological findings of HBeAg negative chronic hepatitis B patients with high viral replication and normal ALT levels
Session: Poster Abstract Session: Viral Infections; Pathogenesis and Epidemiology
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
ID-Week-Dr.Rahmet-Guner.pdf (308.9 kB)


Background: To investigate liver damage and correlation between serum HBV DNA and quantitative HBsAg in HBeAg negative chronic Hepatitis B patients whose serum ALT levels are persistantly normal and HBV DNA levels are higher than 10.000 copies/mL.

Methods: The patients who are HBsAg positive, HBeAg negative, older than 35 years old and whose HBV DNA levels are higher than 104 copies/mL while ALT level is normal at least one year before liver biopsy were included in the study. Liver needle biopsy was performed at all of the patients. Liver histopathologic findings were assessed by same pathologist according to the Ishak scoring system. Furhermore, HBV DNA and quantitative HBsAg were investigated from the patient's blood sample that are taken in the day of the liver biopsy. Chronic hepatitis B treatment indication was confirmed if necroinflamation score was >7 or fibrosis score was ≥2 according to the Ishak scoring system. SPSS 16.0 version was used for analysis of data.

Results: Thirty patients were included in this study. Male and female patients were distrubuted equally. Mean age was 47,2 years (35-73 years). Moderate or over inflamation were detected in 6,7% of the patients. As seen in table 1, 30% of the patients' fibrosis score was ≥2 and these patients were decided to be treated and treatment was started for these patients (Table 1). Necroinflamation and fibrosis score were different  between the groups with low-normal and high-normal ALT. There was a good association between HBsAg and HBV DNA levels and between fibrosis score and HBV DNA levels.

Conclusion: HBV infections have a different course in HBeAg negative patients. Liver biopsy should be done irrespective from serum ALT levels to the patients who are older than 35 years old in this group. HBsAg quantitation is a good marker as an alternative to HBV DNA in staging of chronic HBV infection.

Table 1: Results of liver biopsies.

                                                 Number (%)

Histologic Activity Index (Ishak Scoring System)

Mild (0-6)                                 28 (93,3)

Moderate (7-9)                          2 (6,7)

Severe (>9)                              0

Fibrosis Score

0-1                                           21 (70)

2-6                                           9 (30)


Siran Keske, MD1, Rahmet Guner, Prof. Dr.2, Mehmet A. Tasyaran, Prof. Dr.2, Gul Ruhsar Yilmaz, Ass. Prof.3 and Serdar Balci, MD4, (1)Infectious Diseases and Clinical Microbiology, Polatli Duatepe State Hospital, Ankara, Turkey, (2)Infectious Diseases and Clinical Microbiology, Yildirim Beyazit University, Faculty of Medicine, Ankara, Turkey, (3)Infectious Diseases and Clinical Microbiology, Ataturk Education and Research Hospital, Ankara, Turkey, (4)Pathology, Yildirim Beyazit University, Faculty of Medicine, Ankara, Turkey

StephenW

背景：探讨HBeAg阴性慢性乙型肝炎患者的血清， ALT水平persistantly正常和HBV DNA水平高于10.000拷贝/毫升血清HBV DNA和HBsAg定量肝损害之间的相关性。

方法：将患者HBsAg阳性， HBeAg阴性，年龄超过35岁，其HBV DNA水平高于104拷贝/ ml ， ALT水平正常肝活检前至少一年，包括在研究。在所有的患者进行肝穿刺活检。肝组织病理学结果进行了评估，根据的伊沙克得分系统相同的病理学家。 furhermore ， HBV DNA和HBsAg定量在天的肝活检采取从患者的血液样品进行了调查。慢性乙型肝炎治疗指征确认如果necroinflamation得分为7或纤维化评分≥2 ，根据的伊沙克得分系统。采用SPSS 16.0版本的数据进行分析。

结果： 30例患者纳入本研究。男性和女性患者同样distrubuted 。平均年龄为47.2岁（ 35-73岁） 。 6,7 ％的患者中检测到中度或过炎症。在表1中可以看出，30％的患者的纤维化评分为≥2 ，并决定这些患者进行处理和治疗开始对这些病人（表1） 。的Necroinflamation和纤维化评分分别为不同群体之间的ALT正常低值和高正常。有一个很好的HBsAg和HBV DNA水平与纤维化评分和HBV DNA水平之间的关联。

结论：乙肝病毒感染在HBeAg阴性患者中有一条不同的路线。应做肝活检，不论谁是年龄超过35岁，在这组患者血清ALT水平。乙肝表面抗原定量是一个很好的标志物作为替代分期慢性HBV感染HBV DNA 。

表1：肝活检的结果。


                               数目（％）

组织学活动指数（伊沙克评分系统）

温和的 (0-6 ）          28 （ 93,3 ）

中度（7-9）             2 （6,7 ）

重度（ > 9 ）          0

纤维化评分

0-1                         21 （70 ）

2-6                        9 （30 ）

咬牙硬挺

感谢分享

jinpaimanman

意思是小三阳DNA>5次方，ALT正常的，70%纤维化S0~S2，30% S2~S4吗，，，最后那句看不明白：结论：乙肝病毒感染在HBeAg阴性患者中有一条不同的路线。应做肝活检，不论谁是年龄超过35岁，在这组患者血清ALT水平。乙肝表面抗原定量是一个很好的标志物作为替代分期慢性HBV感染HBV DNA 。

StephenW

回复 jinpaimanman 的帖子

意思是小三阳DNA>5次方，ALT正常的，70%纤维化S0~S2，30% S2~S4吗，，，最后那句看不明白：结论：乙肝病毒感染在HBeAg阴性患者中有一条不同的路线。应做肝活检，不论谁是年龄超过35岁，在这组患者血清ALT水平。乙肝表面抗原定量是一个很好的标志物作为替代分期慢性HBV感染HBV DNA 。

小三阳DNA> 10 ** 4拷贝/ ml (10,000 copies/ml ~= 2,000 iu/ml)ALT正常的，70%纤维化S0~S2，30% S2~S4吗.

乙肝病毒感染在HBeAg阴性患者中有一条不同的路线 - 我想，意思是：在HBeAg阳性（免疫耐受阶段），HBVDNA高，转氨酶正常，通常很小纤维化. 但在HBeAg阴性，事实并非如此.


应做肝活检，不论谁是年龄超过35岁，在这组患者血清ALT水平 - 年龄超过35岁，DNA > 10 ** 4拷贝/ ml, ALT是否正常,都应做肝活检.


乙肝表面抗原定量是一个很好的标志物作为替代分期慢性HBV感染HBV DNA 。- 乙肝表面抗原定量可以代替代HBV DNA [没有数据在摘要]

疯一点好

很多文献都把小三阳说的严重一些，类似我们这样的小三阳还有人喻为癌前病变呢，恐惧啊。

jinpaimanman

回复 疯一点好 的帖子

结果： 30例患者纳入本研究。男性和女性患者同样distrubuted 。平均年龄为47.2岁（ 35-73岁） 。
6,7 ％的患者中检测到中度或过炎症。
93。3%的人只有轻度炎症
30％的患者的纤维化评分为≥S2
70%的患者的纤维化评分为只有S0~S1

那也没有你说的这么恐慌